Cardio-Renal Syndrome: A double edged sword

Naranjo, Mario; Lerma, Edgar V.; Rangaswami, Janani

doi:10.1016/j.disamonth.2017.02.001

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…Of the five subtypes of CRS (Ronco et al, 2008), type 2 CRS is described as chronic cardiorenal syndrome, which refers to progressive, chronic kidney disease caused by chronic cardiac dysfunction. Current treatment options for type 2 CRS include diuretics, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers, β-blockers, vasodilators, inotropic drugs, erythropoiesis-stimulating agents, vasopressin receptor 2 antagonists, and dialysis (Naranjo et al, 2017). However, many of these drugs target heart failure (HF) and can worsen renal function.…”

Section: Introductionmentioning

confidence: 99%

Time Course of the Effects of Buxin Yishen Decoction in Promoting Heart Function and Inhibiting the Progression of Renal Fibrosis in Myocardial Infarction Caused Type 2 Cardiorenal Syndrome Rats

et al. 2019

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This study aimed to investigate the therapeutic effect of traditional Chinese medicine-Buxin Yishen decoction (BXYS) on type 2 cardiorenal syndrome (CRS) caused by myocardial infarction and explore the possible mechanism BXYS works. A chronic heart failure (CHF) rat model induced by left anterior descending coronary artery ligation was used and five groups were created that included a sham group, a CHF model group, a fosinopril group, a BXYS (0.4 g/kg) group and a BXYS (0.8 g/kg) group. Heart function, renal hemodynamics, neuroendocrine factors, serum, and urine concentration of soluble form connective tissue growth factor (sCTGF), expression of CTGF mRNA, CTGF, α-smooth muscle actin (α-SMA), and low-density lipoprotein receptor-related protein (LRP) in renal tissues were evaluated after 28 days and 60 days of drug administration. Histological analysis of kidney tissues was also performed. In vitro experiments were designed to verify the results of in vivo experiments by detecting factors including CTGF, α-SMA, in NRK-52E cells. Rats with CHF showed obvious pathophysiological changes including: altered renal hemodynamic parameters; dysregulated heart function; changes to serum concentrations of angiotensin II (AngII), cyclic guanosine monophosphate (cGMP), serum creatinine (Scr), blood urea nitrogen (BUN), C-reactive protein (CRP), brain natriuretic peptide (BNP); high serum and urine sCTGF concentration; high CTGF mRNA, CTGF, α-SMA and LRP expression in renal tissues; increased extracellular matrix (ECM) deposition and fibrosis in renal tissues. Treatment of BXYS was correlated with a restoration of heart function and improvement of renal hemodynamics, lower serum and urine sCTGF, lower CTGF mRNA, CTGF, α-SMA and LRP expression in renal tissues and lower ECM deposition. In addition, in vitro experiments showed that treatment with BXYS reduced the α-SMA and LRP concentration in NRK-52E cells, which were similar in vivo experiments. In conclusion, the current study provided evidences that BXYS played a role in improving heart function and delaying the progress of renal fibrosis. Meanwhile, the CTGF-LRP pathway might be one of the therapeutic targets for myocardial infarction caused type 2 CRS which showed a positive change after BXYS treatment and is worthy of further exploration.

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Section: Introductionmentioning

confidence: 99%

Time Course of the Effects of Buxin Yishen Decoction in Promoting Heart Function and Inhibiting the Progression of Renal Fibrosis in Myocardial Infarction Caused Type 2 Cardiorenal Syndrome Rats

et al. 2019

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“…5, 6 Definisi ini dibuat untuk mengelompokkan berbagai hubungan antara kondisi akut dan kronis pada penyakit jantung dan ginjal. 5,6 Beberapa penelitian menemukan bahwa ureum dan kreatinin serum dapat digunakan sebagai penanda mortalitas pada pasien dengan sindrom koroner akut yang harus menjalani follow up jangka panjang. 7,8 Ureum adalah produk akhir metabolisme protein dan lebih dari 90% diekskresikan oleh ginjal.…”

Section: Pendahuluanunclassified

Analisis rasio BUN/kreatinin pada pasien infark miokard akut di RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Tarau

Wibawa

Esa

et al. 2020

Intisari Sains Medis

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Background: Heart disease is one of the highest mortality diseases and 30% is caused by acute myocardial infarction (AMI). Kidney disease is one of the complications that occurred in patients with acute myocardial infarction. Several previous studies have reported a high incidence of Acute Kidney Injury (AKI) in patients with AMI (10-27%); the incidence is more elevated when accompanied by cardiogenic shock (50%). Serum BUN and creatinine tests are used to monitor the course and prognosis of renal disorder. This study aims to analyze the BUN/creatinine ratio in IMA patients.Methods: A retrospective cohort study by taking secondary data from medical records in 80 AMI patients (STEMI and NSTEMI) at Dr. Wahidin Sudirohusodo Hospital, Makassar, for January 2017-December 2018. The variables assessed in this study were age, gender, diagnosis, history of the disease, BUN, creatinine, and BUN/creatinine ratio. Data were analyzed using SPSS version 17 for Windows.Results: There was a significant difference between the first examination of ureum (p<0.001), creatinine (p=0.047), and the ratio of BUN/creatinine (p<0.001) with the second examination during treatment in IMA patients, which was higher at the second examination, but there was no association between BUN/creatinine ratio of IMA patients at the first examination with the incidence of renal disorder during treatment (p=0.757).Conclusion: A significant increase of urea and creatinine levels, as well as BUN/creatinine ratio, was found in AMI patients treated at Dr. Wahidin Sudirohusodo Hospital, Makassar. However, no association was found between an increase in the BUN/creatinine ratio and the patient's renal impairment. Latar Belakang: Penyakit jantung merupakan salah satu penyebab kematian tertinggi dan sebanyak 30% disebabkan oleh infark miokard akut (IMA). Penyakit ginjal merupakan salah satu komplikasi yang dapat terjadi pada pasien infark miokard akut. Beberapa penelitian sebelumnya telah melaporkan tingginya insiden AKI pada pasien IMA (10-27%), insidennya semakin tinggi bila disertai syok kardiogenik (50%). Tes serial BUN dan Kreatinin serum digunakan untuk memantau perjalanan dan prognosis penyakit ginjal. Penelitian ini bertujuan untuk menganalisis hubungan rasio BUN/kreatinin pada pasien IMA.Metode: Penelitian ini bersifat kohort retrospektif dengan mengambil data sekunder dari rekam medis pada 80 pasien IMA (STEMI dan NSTEMI) yang dirawat di RSUP DR. Wahidin Sudirohusodo, Makassar periode Januari 2017-Desember 2018. Variabel yang dinilai pada penelitian ini meliputi usia, jenis kelamin, BUN, kreatinin, maupun rasio BUN/kreatinin serum. Data dianalisis dengan piranti lunak SPSS versi 17 untuk Windows. Hasil: Penelitian ini menunjukkan terdapat perbedaan bermakna pemeriksaan pertama ureum (p<0,001), kreatinin (p=0,047), dan rasio BUN/kreatinin (p<0,001) dengan pemeriksaan kedua selama perawatan pada pasien IMA, yaitu lebih tinggi pada pemeriksaan kedua, akan tetapi tidak terdapat hubungan rasio BUN/kreatinin pasien IMA pada pemeriksaan pertama dengan kejadian gangguan fungsi ginjal selama perawatan (p=0,757).Simpulan: Berdasarkan hasil penelitian, ditemukan peningkatan yang signifikan dari kadar ureum, kreatinin, dan rasio BUN/kreatinin pasien IMA yang dirawat di RSUP Dr. Wahidin Sudirohusodo, Makassar. Akan tetapi, rasio BUN/kreatinin tidak dapat dijadikan sebagai prediktor terhadap gangguan fungsi ginjal pasien IMA.

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“…Cardio-renal syndrome can only partially be explained by haemodynamic factors [4]. Therefore, the pathophysiology of renal dysfunction in HF is complex, including many biochemical, structural, thrombotic, and endocrinological abnormalities that affect this condition [5]. It must also be realized that both HF and renal failure (RF) are characterized by a hypercoagulability state [6][7][8][9][10][11], which is one of the 3 basic elements of the Virchow triad, including endothelial dysfunction and blood stasis, with inflammation recently added.…”

Section: Introductionmentioning

confidence: 99%

Coagulation abnormalities as predictors of renal dysfunction in heart failure with reduced ejection fraction

Połaska¹,

Kowalik²,

Kozar-Kamińska³

et al. 2023

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Introduction: Heart failure (HF) is a prothrombotic state that is also associated with the progression of renal dysfunction. However, it is unknown whether coagulation abnormalities are associated with progressive cardiorenal syndrome. Aim of the research:To evaluate activators and inhibitors of coagulation and fibrinolysis and their relationship with renal failure in HF patients. Material and methods: Coagulation biomarkers such as thrombin-antithrombin III, human tissue-type plasminogen activator, human plasminogen activator inhibitor, von Willebrand factor (vWF), soluble thrombomodulin (sTM), human prothrombin fragments (F1+F2), and protein C were evaluated in 36 consecutive HF patients without anticoagulation and in 19 controls matched in age and gender. Results: HF patients, compared to controls, had lower levels of C protein (p = 0.04) and F1 + F2 (p < 0.001) but higher levels of vWF (p < 0.001) and borderline sTM (p = 0.07). Similarly, haemoglobin (p < 0.001) and glomerular filtration rate (GFR) (p = 0.004) were lower in HF, while INR (p < 0.001), NT-proBNP (p < 0.001), and asymmetric dimethylarginine (ADMA) (p < 0.001) were higher. Most of the echocardiographic parameters differed between the 2 groups. From coagulation biomarkers, sTM (r = -0.66; p < 0.001) and vWF (r = -0.41; p = 0.002) were associated with eGFR. Most of the echocardiographic and laboratory parameters were also related to eGFR. After classifying all variables into 5 categories; laboratory tests, echocardiographic parameters, vascular reactivity, haemodynamics, and coagulation parameters, multivariable linear regression showed that coagulation parameters were the most strongly associated with eGFR (r 2 = 0.48, p < 0.001). Conclusions: In the study population, coagulation disorders were most strongly associated with impaired renal function, independently of other parameters. StreszczenieWprowadzenie: Niewydolność serca (HF) jest stanem zwiększonej gotowości zakrzepowej, z często współwystępującą dysfunkcją nerek. Jednak dotąd nie wykazano związku zaburzeń w obrębie biomarkerów zakrzepowych z postępującym zespołem sercowo-nerkowym. Cel pracy: Ocena związku biomarkerów zakrzepowych z upośledzeniem funkcji nerek u chorych z niewydolnością serca. Materiał i metody: Biomarkery zakrzepowe, takie jak kompleksy trombina-antytrombina III, tkankowy aktywator plazminogenu, czynnik von Willenbranda (vWF), rozpuszczalna trombomodulina (sTM), fragmenty protrombiny (F1 + F2) oraz białko C, zostały ocenione u 36 chorych z niewydolnością serca nieleczonych przeciwzakrzepowo oraz u 19 zdrowych ochotników w grupie kontrolnej, dobranej pod względem wieku i płci. Wyniki: Pacjenci z niewydolnością serca w porównaniu z grupą kontrolną mieli niższą aktywność białka C (p = 0,04), ale wyższe stężenia vWF (p < 0,001) i graniczną istotność dla sTM (p = 0,07). Hemoglobina (p < 0,001) oraz przesączanie kłębuszkowe (eGFR) (p = 0,004) były niższe w grupie z HF, podczas gdy INR (p < 0,001), NT-proBNP (p < 0.001) i asymetryczna Coagulation abnormalities as predictors of re...

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Cardio-Renal Syndrome: A double edged sword

Cited by 7 publications

References 19 publications

Time Course of the Effects of Buxin Yishen Decoction in Promoting Heart Function and Inhibiting the Progression of Renal Fibrosis in Myocardial Infarction Caused Type 2 Cardiorenal Syndrome Rats

Time Course of the Effects of Buxin Yishen Decoction in Promoting Heart Function and Inhibiting the Progression of Renal Fibrosis in Myocardial Infarction Caused Type 2 Cardiorenal Syndrome Rats

Analisis rasio BUN/kreatinin pada pasien infark miokard akut di RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Coagulation abnormalities as predictors of renal dysfunction in heart failure with reduced ejection fraction

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